Kelley Lee is at the London School of Hygiene & Tropical Medicine, London, United Kingdom. E-mail:
The author has declared that no competing interests exist.
Kelley Lee discusses a research article by Stanton Glantz and colleagues reporting that investment in tobacco control programs leads to substantial savings in health care expenditures.
Over the past half century, one of the most familiar and effective arguments put forth by the tobacco industry to defend its business and minimise its regulation is that it generates net economic benefits to society. Put simply, industry advocates claim that taxation, profits, and employment associated with tobacco far outweigh any costs imposed on societies and in particular on health care systems. For decades, this argument has been trotted out in mantra-like fashion around the world whenever stronger tobacco control measures, such as higher taxation or market restrictions, are mooted. And by and large, governments have bought into the belief that tobacco control is simply unaffordable.
Beginning in the mid-1980s, public health researchers began to apply economic methods in an attempt to challenge industry claims. In his 1986 paper “Economics and Cigarettes”, Thomas Schelling (winner of the 2005 Nobel Prize for economics) applied the economic concept of an “accounting framework”, comprising such elements as lost lives, lost livelihoods, excise taxes, costs of regulating smoking behaviours, and medical costs, to assessing the economic impacts of tobacco production and consumption [
This Perspective discusses the following new study published in
Lightwood JM, Dinno A, Glantz SA (2008) Effect of the California Tobacco Control Program on personal health care expenditures. PLoS Med 5(8): e178. doi:
Stanton Glantz and colleagues find that the California state tobacco control program is associated not only with reduced smoking, but with reductions in health care costs as well.
In the August 2008 issue of
The authors point out that the nature of the programme's activities, alongside sustained levels of appropriate funding, was an important factor in its success. In California, tobacco control messages were targeted at the general population (as opposed to youth prevention), resulting in more immediate effects on cessation and associated morbidity. This finding is important at a time when tobacco companies have aggressively promoted their own “youth smoking education and prevention” programmes worldwide, designed as flagships for corporate social responsibility initiatives and with dubious intent [
The relevance of these lessons—the need for increased and consistent public funding and broadly targeted activities—go far beyond California. In other US states, despite large sums of money derived from tobacco taxation and legal settlements, relatively little of these funds have been invested in tobacco control. This has been the case especially where pressures on public spending cause the diversion of funds elsewhere. Globally, the US$1.8 billion spent in California on tobacco control, averaging US$120 million annually or US$3.29 per capita (based on California's 2006 population of around 36.5 million), dwarfs the budgets of most national tobacco control programmes. In a survey of 30 European countries, Joossens and Raw found that tobacco control programme budgets for 2006 ranged from €238,215 (US$371,000) or US$0.01 per capita for Romania, to €108,196,235 (US$168.5 million) or US$2.79 per capita for England [
As well as challenging industry claims that tobacco is a necessary economic evil, therefore, Glantz and colleagues raise questions about the spending priorities of governments on public health. As tobacco is the leading cause of premature death and disease, responsible for 5.4 million deaths each year [
Framework Convention on Tobacco Control